Medicines to treat behaviour problems in Alzheimer's disease and other dementias
Medicines can be used to treat behaviour problems caused by Alzheimer's disease and other diseases that cause dementia. They should be used only after other non-drug approaches have failed to improve a person's symptoms. Medicine may be needed when the person is in danger of harming himself or herself or others or when the caregiver is unable to deal with the situation using other means.
Antipsychotic medicines may help relieve more severe agitation or psychosis (disordered thought processes).
- Low doses may make the person more comfortable by reducing certain symptoms, such as delusions, suspicion of others (paranoia), hallucinations, hostility, or agitation.
- These medicines also may improve sleep.
- The side effects may make some symptoms of Alzheimer's disease worse, such as apathy, withdrawal from family and friends, and inability to think clearly.
- These are powerful medicines. They commonly cause dizziness, drowsiness, movement disorders that resemble Parkinson's disease, low blood pressure upon standing (orthostatic hypotension), and other side effects.
Examples of medicines sometimes used to treat hallucinations, paranoia, and severe agitation in people with dementia include haloperidol, risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa).
Some of these medicines have some known risks:
- In June 2005, Health Canada issued a public health advisory to alert people about the higher risk of death in people with dementia who used atypical antipsychotics. Atypical antipsychotics include Zyprexa, Risperdal, Seroquel, and Clozaril (clozapine). Zyprexa, Seroquel and Clozaril are not approved to treat dementia. However, Risperdal is approved for short-term treatment in some people with severe dementia.1 Health Canada asked the makers of these drugs to include a warning on the safety information sheet for these medicines that describes the increased death risk.1
- The makers of Risperdal have issued a warning that older adults taking this medicine may have a slightly higher risk of stroke.
Discuss these risks with the person's doctor before deciding to try these medicines.
Anti-anxiety medicines, including minor tranquilizers, relieve anxiety and mild agitation and may help calm the person. However, they can cause drowsiness if the dose is too high. When minor tranquilizers are needed, short-term or occasional use often is better than continuous use.
Oxazepam (Oxpam) and lorazepam (Ativan) are minor tranquilizers sometimes used in treating dementia. Another anti-anxiety medicine called buspirone (BuSpar) also can be tried.
- These medicines may increase confusion and upset the person's balance, raising the risk of falls.
- A person may become dependent on these medicines over time, causing even worse symptoms when he or she suddenly stops taking them. To avoid this problem, these drugs usually are stopped gradually after a few weeks of use.
Anticonvulsant medicines, such as carbamazepine (Tegretol) or valproic acid (Depakene), may be used to control agitation, violent behaviour, and mood swings caused by dementia.
Other medicines that may be used to treat agitation include trazodone (Desyrel) or a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), or escitalopram (Cipralex). However, research on the effectiveness of these medicines in Alzheimer's disease and other dementias is limited.
Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. It is not recommended that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.
Anticonvulsants may increase the risk of suicide and suicidal thoughts. It is not recommended that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.
See Drug Reference for more information about all of these medicines. (Drug Reference is not available in all systems.)
| Author: | Douglas Dana Sabra L. Katz-Wise Ralph Poore | Last Updated: January 26, 2007 |
| Medical Review: | Adam Husney, MD - Family Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine Peter J. Whitehouse, MD - Neurology | |
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